WORK INCENTIVE BENEFITS

Expedited Reinstatement (EXR) 

EXR (SSDI) - 

An individual is requesting that SSA reinstate a prior period of disability; therefore insured status is not an issue.

New Initial Claim (SSDI) - 

Insured Status for a new period of disability must be considered.

Protective Filing:

EXR - is a protective filing for an initial claim

New Initial Claim - is not a protective filing for an EXR

• The Medical Review for EXR is different than an initial claim.

• EXR - SSA finds an individual eligible if their current condition(s) is the same as or related to the condition(s) for which they were originally approved and they have not medically improved. 
• New Initial Claim - SSA finds an individual eligible if SSA determines that they cannot perform Substantial Gainful Activity (SGA) because they have a medical condition that is expected to last at least one year (or result in death.)

ARE YOU ELIGIBLE?

• If you are an SSDI or SSI beneficiary who: Stopped receiving benefits because of earnings from work
• Are unable to work or perform substantial gainful activity,  
• Are disabled because of an impairment(s) that is the same as or related to the impairment(s) that allowed you to get benefits earlier, and make the request within 5 years from the month your benefits ended.

RETROACTIVITY

• Both EXR and new initial claim  (SSDI) are eligible for up to 12 months of retroactive benefits if medically disabled and not performing Substantial Gainful Activity (SGA.)  
• EXR - The date of entitlement cannot be before the date benefits are terminated. Unsuccessful work Attempts (UWA) or averaging do not apply.
• New initial Claim - The date of entitlement cannot be before the last period of Substantial Gainful Activity

(SGA) work, but Unsuccessful Work Attempts (UWA) and averaging can apply. 

1. The benefit amount for EXR may be different than the benefit amount for a new initial claim. This varies on a case-by-case basis and will be explained at the time of the claims interview.
2. EXR - SSA pays up to 6 months of provisional benefits while we make a medical decision.
3. New Initial Claim - SSA does NOT pay provisional benefits.

To maintain Medicare coverage, the individual must remain medically eligible.

1. EXR - If SSA denies the request for ERX because of medical improvement, Medicare coverage will terminate.
2. New Initial Claim - Medicare coverage is NOT terminated if SSA denies the claim. 
3. SSA will conduct a medical review to determine eligibility for extended Medicare coverage. 

The Trial Work Period (TWP) is 9 months in which an SSDI beneficiary can earn as much money as they can and still receive cash benefits.

1. EXR (SSDI): After 24 months of EXR payments, the beneficiary is eligible for a new TWP and 36-month Extended Period of  Eligibility (EPE). This is called the initial Reinstatement Period (IRP).
2. New Initial Claim (SSDI): Beneficiary is eligible for a new TWP (Trial Work Period) followed by a new 36-month EPE (Extended Period of Eligibility).

The month SSA reinstates disability payments (EXR) is the first month of the IRP.

1. The initial reinstatement period (IRP) can last for 24 months (NOT necessarily consecutive) and ends when the Beneficiary has received 24 months of payable benefits.
2. For SSDI, SSA pays benefits for any month during the IRP that earnings are NOT SGA (Substantial Gainful Activity).
3. For SSI, the regular income and resource counting rules apply.

1-800-772-1213

OR VISIT YOUR SSA FIELD OFFICE.